Immune thrombocytopenic purpura: Difference between revisions
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*Petechiae | *Petechiae | ||
*Epistaxis, gingival bleeding, menorrhagia | *Epistaxis, gingival bleeding, menorrhagia | ||
==Differential Diagnosis== | |||
==Diagnosis== | ==Diagnosis== | ||
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*CBC shows normal cell lines except for the platelets (may have mild anemia) | *CBC shows normal cell lines except for the platelets (may have mild anemia) | ||
== | ==Management== | ||
===Options=== | |||
*'''First choice in adults:''' Corticosteroids | *'''First choice in adults:''' Corticosteroids | ||
**Prednisone 60-100 mg/d with taper after count reaches normal | **[[Prednisone]] 60-100 mg/d with taper after count reaches normal | ||
**Methylprednisolone 30mg/kg/d IV x 3 days (for life-threatening bleeding) | **[[Methylprednisolone]] 30mg/kg/d IV x 3 days (for life-threatening bleeding) | ||
*'''First choice in children:''' Intravenous Immunoglobulin G (IVIG) 1gm/kg/d x 2 days | *'''First choice in children:''' Intravenous Immunoglobulin G (IVIG) 1gm/kg/d x 2 days | ||
*Anti-D (RhoGAM): patient must be Rh+ for it to work | *Anti-D ([[RhoGAM]]): patient must be Rh+ for it to work | ||
* | *[[Platelet transfusion]] | ||
**Indicated for life-threatening bleeding | **Indicated for life-threatening bleeding | ||
**Transfuse only following first dose of methylprednisolone or IVIG | **Transfuse only following first dose of [[methylprednisolone]] or IVIG | ||
***Holding transfusion until after first dose results in greater rise in platelet count | ***Holding transfusion until after first dose results in greater rise in platelet count | ||
*Estrogen for uterine bleeding: 25mg IV x1 | *Estrogen for uterine bleeding: 25mg IV x1 | ||
== | ===Indications=== | ||
===Adults=== | ====Adults==== | ||
*Plt >30K and asymptomatic: usually do not require treatment | *Plt >30K and asymptomatic: usually do not require treatment | ||
*Plt count <30K: prednisone | *Plt count <30K: prednisone | ||
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*Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion | *Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion | ||
===Children=== | ====Children==== | ||
*Platelet count >30K: usually do not require treatment | *Platelet count >30K: usually do not require treatment | ||
*Platelet count <20K + significant bleeding: IVIG | *Platelet count <20K + significant bleeding: IVIG | ||
Revision as of 05:09, 6 June 2015
Background
- Acquired autoimmune disease resulting in destruction of platelets
- Because circulating platelets are functional, life-threatening bleeding only once platelet count <10K
Types
- Acute
- More common among younger children
- Affects men/women equally
- Resolves in 1-2 months
- Chronic
- Lasts > 3 months
- More common in adults and women
- Rarely remits spontaneously or with treatment
- More likely to have an underlying disease or autoimmune disorder (e.g. SLE)
Clinical Features
- Petechiae
- Epistaxis, gingival bleeding, menorrhagia
Differential Diagnosis
Diagnosis
- Diagnosis of exclusion
- Must differentiate acute ITP from chronic ITP, which suggests an underlying disorder
- CBC shows normal cell lines except for the platelets (may have mild anemia)
Management
Options
- First choice in adults: Corticosteroids
- Prednisone 60-100 mg/d with taper after count reaches normal
- Methylprednisolone 30mg/kg/d IV x 3 days (for life-threatening bleeding)
- First choice in children: Intravenous Immunoglobulin G (IVIG) 1gm/kg/d x 2 days
- Anti-D (RhoGAM): patient must be Rh+ for it to work
- Platelet transfusion
- Indicated for life-threatening bleeding
- Transfuse only following first dose of methylprednisolone or IVIG
- Holding transfusion until after first dose results in greater rise in platelet count
- Estrogen for uterine bleeding: 25mg IV x1
Indications
Adults
- Plt >30K and asymptomatic: usually do not require treatment
- Plt count <30K: prednisone
- Plt <50K AND bleeding: prednisone
- Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion
Children
- Platelet count >30K: usually do not require treatment
- Platelet count <20K + significant bleeding: IVIG
- Platelet count <10K: IVIG
- Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion
Disposition
- Admit: platelet count <20K or significant mucous membrane bleeding
- Discharge: platelet count >20K AND asymptomatic OR only minor petechiae
Complications
- Rare: more common in elderly
- Intracerebral bleeding
- Severe GI bleeding